Abstract
Distal radioulnar joint (DRUJ) instability is a debilitating complication that may occur following distal radius fractures. Surgical treatment of DRUJ instability remains a challenge. This is a case that highlights a unique surgical approach integrating sigmoid notch osteoplasty and DRUJ reconstruction using a gracilis tendon allograft. It focuses on a 41-year-old woman who sustained comminuted intra-articular distal radius and ulna fractures in Jamaica, leading to chronic DRUJ instability. She underwent multiple surgeries and various conservative treatments, none of which resolved her symptoms. Ultimate surgical intervention combining bone grafting with allograft reconstruction addressed both bony and ligamentous deficiencies, which successfully improved her symptoms. Six months after surgery, the patient exhibited significant functional improvement and stable DRUJ anatomy. This case demonstrates the importance of addressing both bony and soft tissue structures in chronic DRUJ instability and provides a novel combination of techniques that serve as a foundation for future surgical intervention.